10.12.02.03

.03 Alleged Rape or Sexual Offense Victim Care.

A. The victim shall be considered an emergency patient with special needs. The victim shall be taken immediately to a quiet private area where tests and examinations will be performed on the victim. The following measures are indicated under certain circumstances:

(1) Prophylactic medication shall be discussed and offered to the victim who is at risk for pregnancy as a result of the alleged rape or sexual assault;

(2) Prophylactic medication shall be discussed and offered to the victim who is at risk for sexually transmitted infections and recommended initial tests and follow-up tests shall be performed, if indicated;

(3) After the victim has been properly informed as to the significance of testing for the presence of the human immunodeficiency virus (HIV), the victim shall be referred to the appropriate anonymous or confidential, and free HIV counseling and test sites for potential baseline and follow-up testing and support services;

(4) Injuries suffered by the victim shall be treated with appropriate consultation, as necessary; and

(5) Tetanus prophylaxis may be administered, if indicated.

B. Sexual Assault.

(1) A sexual assault forensic examination shall be performed if:

(a) The victim is seen within 120 hours of the alleged sexual offense; and

(b) Either:

(i) A police report has been filed with the appropriate law enforcement jurisdiction; or

(ii) A property-held number is assigned to the case in the event that a victim does not wish to file a police report immediately but still seeks to have evidence collected and held.

(2) A sexual assault forensic examination shall be performed only by a:

(a) Physician; or

(b) Forensic nurse examiner.

(3) When performing a sexual assault forensic examination, a physician or a forensic nurse examiner shall use the Maryland State Police victim sexual assault evidence collection kit or a comparable evidence collection kit and shall follow the kit instructions including:

(a) Packaging the victim's clothing in paper bags; and

(b) Collecting the following specimens:

(i) Blood sample (lavender cap);

(ii) Vaginal swabs (a minimum of four);

(iii) Oral swabs (a minimum of two);

(iv) Pubic hair combings;

(v) Pulled pubic hair;

(vi) Pulled head hair; and

(vii) If indicated, anal swabs, bite mark swabs, and fingernail scrapings.

C. A physician or forensic nurse examiner shall follow the procedures as indicated to establish evidence of alleged rape or sexual offense, depending on the specifics of the crime as described by the victim:

(1) Obtain from each of the following areas, if indicated, a smear to be fixed and stained according to the Papanicolaou technique:

(a) Endocervical canal;

(b) Vaginal pool;

(c) Vulva;

(d) Mouth; and

(e) Anal area;

(2) Obtain culture for gonorrhea from cervix, rectum, and nasopharynx, if indicated, and plate it immediately;

(3) Obtain vaginal, oral, or rectal aspirate for acid phosphatase testing, if indicated;

(4) Obtain a blood sample for syphillis testing and refer patient to a healthcare provider of choice for repeat sample in 4—6 weeks;

(5) Obtain X-rays necessary to establish evidence of physical injuries sustained as a direct result of the alleged rape or sexual offense; and

(6) Obtain either a urine sample or a blood sample for beta subunit of human chorionic gonadotropin for a pregnancy test and recommend and refer the victim to a healthcare provider of choice for a second test in 4—6 weeks, if indicated.

D. A physician or forensic nurse examiner shall submit the evidence collected to the appropriate law enforcement jurisdiction.